Every day we seem to hear a story about a concussion. The topic is prevalent in the news and especially with the start of fall sports. While there have been many front page articles speculating on the sometimes chronic or even tragic consequences athletes may face, a concussion is a brain injury that needs to be managed and treated properly with appropriate education and protocols. It also requires a team effort of athletic trainers, physicians, coaches and others who are responsible for the sports safety of athletes -- from youth to professional levels of participation.
As an athletic trainer, my number one concern is for the health of the athletes under my care. There is no argument that concussions are serious injuries that deserve our attention. Research is helping us understand traumatic brain injuries/concussions much better than we did even a decade ago, yet despite these advances, misinformation still exists in the public sphere. My goal with this article is to address some of those myths, in an effort to make sports safer for athletes of all ages.
Myth #1 -- If you don't lose consciousness you were not concussed.
Fact -- Loss of consciousness used to be one of the signs we used to identify and grade the severity of a concussion. We know today that individuals who have sustained a concussion can have a variety of signs and symptoms that are equally important to consciousness. It is very common for a concussed individual to experience a headache and dizziness or demonstrate balance problems while not ever losing consciousness. In fact, fewer than 10 percent of concussions result in loss of consciousness. Injuries involving loss of consciousness are no more severe than those that don't, but not recognizing the often less dramatic symptoms can result in misdiagnosing individuals as not having a concussion when they in fact do.
The most common signs and symptoms someone will have after sustaining a concussion are headache, confusion, amnesia, dizziness, ringing in the ears, nausea, vomiting, slurred speech, delayed response to questions, fatigue and/or appearing dazed.
Myth #2 -- You can return to play as soon as your symptoms subside.
Fact -- Because signs and symptoms can be subtle or non-existent at rest, experts point out that exercise may cause the symptoms to resurface, indicating incomplete recovery from the initial concussion. The proper management plan for a concussion includes a progressive exercise program with graduated levels of exertion overseen by an appropriately trained health care professional such as an athletic trainer, neuropsychologist or physician who specializes in concussion management. Experts recommend not returning to play following a concussion until an athlete is symptom free at rest and during exertion. Like snowflakes, however, no two concussions are alike and every injury should be managed individually. But under no circumstances should the athlete return to play the same day the concussion occurs.
Myth #3 - You are safe to return to play as long as you only have a headache following a concussion.
Fact -- Many concussions have no outwardly visible signs that stem from the change in brain functioning following injury. The decision to return to play should be based on guidance from a qualified health care professional who will consider several factors when making the determination. Simply trusting self-reported symptoms can result in returning to play too soon and risking a second injury and longer recovery times. In some youth athletes who sustain a second injury, Second Impact Syndrome can result. In these cases, the brain swells very quickly; it is often catastrophic, with a 50 percent chance of fatality. Those who survive can suffer long-term complications.
Myth #4 - I can worry about what to do and where to go after a concussion happens.
Fact -- Waiting until a concussion occurs to develop a plan for managing the injury is often too late. There are steps that should be taken before an athlete sustains a concussion to ensure better management of the injury. The most important steps are to have an athletic trainer on site and to make sure your school /team has an emergency action plan specific to the sport and venue. Preparation for an emergency includes education and training, maintenance of emergency equipment and supplies, appropriate use of and defined roles for the available personnel, and the formation and implementation of a plan in the event of an emergency. Taking these steps will ensure proper preparations have been made to appropriately care for an athlete should any injury occur. It's not enough to assume these important steps have been taken.
You also need to find out who in your community, whether it be a physician, athletic trainer or specialty clinic, is trained and experienced to manage a concussion after it occurs. Many communities have minimal access to appropriately trained health care providers who are comfortable working with patients who suffer from mild traumatic brain injuries. See if your area has a concussion care center or something like it. Often this type of facility incorporates a multi-disciplinary approach to management of concussion.
Another important pre-concussion step is obtaining baseline testing. Often this comes in the form of neurocognitive testing, balance testing and a symptom checklist. The importance of the baseline test is to provide a snapshot of how the brain functions in a non-injured state to assist when making recovery decisions about the concussed athlete. Sometimes this testing is provided by the school. If not, you may be able to obtain a baseline test from a trained concussion specialist in your area.
Myth #5 - Your child will be fine if you just remove him or her from practice and have him or her focus on studies while recovering from concussion.
Fact -- Your child not only needs a return-to-play plan overseen by an appropriately trained health care provider but also needs a return-to-learn plan coordinated with the school and teachers. Remember that a concussion affects the brain. Often the best choice for recovering from a concussion is not only rest from practice and games but rest from using the brain itself as much as possible. If activities such as texting, reading, watching television and playing videogames exacerbate symptoms, they should be avoided as they can prolong the symptoms. When it comes to a concussion, rest refers to more than physical rest; it also includes mental or cognitive rest.
Myth #6 - Playing sports is more harmful to my child than it is good.
Fact -- Sports have tremendous value and help develop several great attributes in young people. They also are one of the best tools we have to help combat the epidemic of obesity in children today. Sports may result in injury regardless of our best efforts to minimize these risks, but we know that a sedentary lifestyle definitely leads to health problems. Get out and play, but be smart about it. Do it for the love of play. Perhaps your children will find an activity they can enjoy playing for the rest of their lives.
While concussed athletes often get upset when they can't participate for a short period of time, our number one concern should be their long-term health and well-being. Proper care and recovering well today gives us the best shot at competing successfully tomorrow.
Scott Sailor, EdD, ATC, is the president of the National Athletic Trainers' Association.